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09/14/2018 07:52 Canepa & Sons (FAX) P.003/010
<br /> JOBADDRESS: 96/1 PERMIT#:
<br /> / A297
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under the provisions of Chapter a((;ommencing with Section 7000)of Division 3 of the Business and
<br /> Professions Code and my license Is In full force and effect.
<br /> Licenae425749 Expiration Date 7/31/2020
<br /> Date 0 Ilk Contractor CANEPA AND SONS,INC,
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031,5,Business and Professions
<br /> Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance,
<br /> also requires the applicant for such permit to file a signed etatemem that he Is licensed pursuant to the provisions of the Contractor's
<br /> License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Coda)or that he is exempt
<br /> herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a civil penalty of not more than five hundred dollars($500)):
<br /> ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and tho structure is not
<br /> intended or offered for sale (Section 7044, Business and Professions Code: The contractor's License Law does not apply to an
<br /> owner of property who builds or improves thereon,and who does such work himself or through his own employees, provided that
<br /> such improvements are not intended or oflered for sale, It, however, the building or Improvement Is sold within one year of
<br /> completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.)
<br /> Q I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(StVloh 7044,Business and
<br /> Professions Code(BBPC): The Contractor's License Law does not apply.to an owner of property who builds or Improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
<br /> Q 1 am exempt under Section , B&PC for this reason
<br /> Date: Owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> I hereby affirm that I have a certificate of consent to self-Insure or a certificate of Workers'Compensation Insurance,or a certified copy
<br /> thereof(Section 3900,Labor Code),
<br /> Expiration Data 7/16/2019 Company CALIFORNIA INSURANCE COMPANY
<br /> O Certified copy Is hereby furnished
<br /> 17 Certified copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be completed If the gejmlt Is fpr eoe ounjrgd:Ioll ,e„(J100)or 1es31
<br /> I certify that In the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to
<br /> become subject to the Workers'Compensation Laws of California.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'Compensation
<br /> provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there is a constructlon lending agency for the performance of the work for which this permit Is Issued(Section 3007,
<br /> Civil Code).
<br /> Lender's Name
<br /> Lender's Address
<br /> c
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> Q I hereby certify that no excavation five (5) or more feet In depth into which a person Is required to descend, will be made In
<br /> connection with work authorized by the permit,and that no building structure,scaffolding,falsework, or demolition or dismantling
<br /> thereof,will be more then thirty-six(36) feet high. (Chapter 3.2,©roup 2,Article 2, Section 341,Title 9, California Administrative
<br /> Code),
<br /> Q As owner builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> ©Division of Industrial Safety Permit*
<br /> I certify that I have read this appllcatlor and state that the above Information is correct. I agree to comply with all etty and county
<br /> ordinances and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> Date Applicant
<br /> EHD 43-42_007 LICENSED CONTRACTORS D�CI.ARATION
<br /> &2&09
<br /> Received Time Sep, 14, 2018 7 : 52AM No, 4137
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